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Neurology > Lecture 14 Multiple Sclerosis > Flashcards

Lecture 14 Multiple Sclerosis Flashcards

1
Q

What part of the CNS does MS affect

A

White matter

Demyelination caused by inflammation of the myelin

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2
Q

What is the age of onset of MS

A

34 years

20-50 years

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3
Q

What is the prevalence amongst genders

A

Women twice as likely to develop it

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4
Q

Symptoms that occur during relapse

A 
Optic neuritis
Sensory symptoms
Limb weakness
Diplopia
Vertigo/ataxia
Bilateral motor and sensory symptoms
Bladder involvement
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5
Q

Describe the symptoms of Optic Neuritis

A 
Sub-acute visual loss
Pain in moving the eye
Colour vision disturbed
Initial swelling of optic disc
Optic atrophy
Relative afferent pupillary defect
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6
Q

Define Myelitis

A

Inflammation of the spinal cord can be partial or transverse

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7
Q

Describe the symptoms of myelitis

A

Hyperaesthesia
Weakness/UMN changes below level
Bladder and bowel involvement
Pins and needles around area

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8
Q

What is the mechanism of demyelination

A

Auto immune process

Activated T cells cross blood brain barrier

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9
Q

Define Clinically isolated syndrome

A

A first episode of neurological symptoms lasting at least 24 hours

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10
Q

What are risk factors of relapses

A

Underlying infections

First 3 months post partum

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11
Q

What leads to progression of disease

A

Axonal loss leads to disease progression and development of persistent disability

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12
Q

What is seen on an MRI when there is axonal loss

A

Black holes

Cerebral atrophy

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13
Q

Describe the progressive phase

A

Accumulation of symptoms and signs

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14
Q

Demyelination in the hypothalamus leads to what

A

Temperature sensitivity

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15
Q

What would you see on examiantion

A 
Afferent pupillary defect
Nystagmus or abnormal eye movement
Cerebellar signs
Sensory signs
Weakness
Spasticity
Hyperreflexia
Plantars extensor
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16
Q

Name 3 types of MS

A

Relapsing remitting
Secondary progressive
Primary progressive

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17
Q

Describe the presentation of primary MS

A 
Primarily involves spinal cord
Difficulty walking
No relapses
Bladder symptoms
UMN lesion pattern
18
Q

How is MS diagnosed

A

Clinical(Posers criteria) or MRI (Macdonald criteria) used

19
Q

During a MRI with Gadolinium what is visible

A

New active lesions

20
Q

During a MRI with no Gadolinium what is visible

A

Lesions from old scars

21
Q

What are the DDx of MS

A 
ADEM
SLE
Sarcoidosis
Vasculitis
Lyme Disease
TB
Adrenoleucodystrophy
22
Q

Name DDx for Optic neuritis

A 
Neuromyelitis optica
Sarcoidosis
Iscahemic otic neropathy
Toxic/drugs/B12 defieciency
Wegners granulomatosis
Local compression
Lebers hereditary optic neuropathy
Infection- TB HIV
23
Q

Differential diagnosis for Myelitis

A 
SLE
Neuromyelitis optica
Darcoidosis
Infection (HIV, TB, Mycoplasma)
Tumour
Paraneoplastic process
Stroke
24
Q

What other infections can be carried out to investigate MS

A

Lumbar puncture
Visual/somatosensory evoked response
Bloods to exclude inflammatory conditoins
CXR

25
Q

Treatment for acute relapse

A

Treat underlying infection or illness
Oral prednisolone (IV)
Symptomatic treatment

26
Q

When would 1st line disease modifying treatments me administered

A

When patient has a high rate of relapses

Administered to reduce relapses does not slow down progression of disease

27
Q

Name some I/C or S/C 1st line treatment

A

Beta-Inteferons

Glatiramer acetate

28
Q

Name some oral 1st line treatments

A

Teriflunomide

Dimethyl fumarate

29
Q

What needs to be monitored when administering 2nd line treatment

A

WBC count, Liver function, overall health

30
Q

Why would a patient need 2nd line treatment

A

Not responding to 1st line treatment

31
Q

Name examples of 2nd line treatment

A 
Natalizumab
Fingolimod
Cladribine
Ocrelizumab
Alemtuzumub
32
Q

How is spasticity treated

A

Muscle relaxants/antispasmodics/physiotherapy

33
Q

How is dysaethesia treated

A

Amitriptyline, gabapentin

34
Q

How is urinary problems treated

A

Anticholinergic, bladder stimulator, catherisation

35
Q

How is constipation treated

A

Laxatives

36
Q

How is sexual dysfunction treated

A

Slidenafil

37
Q

How is fatigued treated

A

Graded exercise, medication

38
Q

How is depression treated

A

CBT, medication

39
Q

How is cognitive issues treated

A

Memory aids

40
Q

How is tremors treated

A

Medication/aids

41
Q

How is vision/ oscillopsia treated

A

Carbamezapine

42
Q

How is speech and swallowing issues treated

A

SALT

Neurology (44 decks)

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